CAJ | 학술논문

目的：对比分析腹腔镜下腹股沟前间隙疝修补术、无张力疝修补术与传统疝修补术的临床疗效。方法2001年1月－2004年3月共42例患者采用传统方法修复腹股沟疝（传统组），2004年4月－2014年12月有39例患者行疝环充填式无张力疝修补术（无张力组），行腹腔镜疝修补术26例（腹腔镜组）。观察3组患者的手术时间、离床时间、住院时间。出院后记录并发症发生情况及复发率。采用视觉模拟评分法 VAS 法对3组患者术后1、3 d 及1 a 随访时疼痛程度进行观察。结果3组手术时间比较差异有统计学意义，腹腔镜组手术时间明显短于传统组（P ＜0．05），但与无张力组比较无差异。3组住院时间、下床活动时间比较差异有统计学意义，腹腔镜组和无张力组住院时间及下床时间明显短于传统组（P ＜0．05），腹腔镜组住院时间短于无张力组，差异有统计学意义（P ＜0．05），腹腔镜组和无张力组下床时间比较差异无统计学意义（P ＞0．05）。腹腔镜组及无张力组术后均未使用镇痛药或肌注止痛针，传统组有14例术后需服用止痛药或肌注止痛针。传统组镇痛药使用率均高于腹腔镜组及无张力组，差异有统计学意义。腹腔镜组术后2例病人发生相关并发症，并发症发生率明显低于传统组及无张力组，差异有统计学意义。3组术后1、3 d VAS 评分比较差异有统计学意义，术后1 a VAS 评分差异无统计学意义。腹腔镜组术后1、3 d 时 VAS 评分明显低于传统组及无张力组，差异有统计学意义。传统组平均复发率为6．8％，1、3年复发率分别为7．1％（3／39）、5．9％（2／34）。无张力组平均复发率为5．8％，1、3年复发率分别为8．3％（3／36）、3．3％（1／30）。腹腔镜组术后随访3 a 仅1例复发，复发率为4．3％（1／23）。结论无张力疝修补术和腹腔镜疝修补术治疗腹股沟疝均取得较好的临床效果，2种术式同样安全有效，又各自有优势。腹腔镜疝修补术在手术创伤、术后疼痛及术后恢复较前2种术式具有明显的优势。疝的修补术应遵循个体化、规范化的原则，根据患者具体情况来决定手术方式，充分考虑疝分型，是否复发，患者的经济条件、年龄、基础疾病等。目的：對比分析腹腔鏡下腹股溝前間隙疝脩補術、無張力疝脩補術與傳統疝脩補術的臨床療效。方法2001年1月－2004年3月共42例患者採用傳統方法脩複腹股溝疝（傳統組），2004年4月－2014年12月有39例患者行疝環充填式無張力疝脩補術（無張力組），行腹腔鏡疝脩補術26例（腹腔鏡組）。觀察3組患者的手術時間、離床時間、住院時間。齣院後記錄併髮癥髮生情況及複髮率。採用視覺模擬評分法 VAS 法對3組患者術後1、3 d 及1 a 隨訪時疼痛程度進行觀察。結果3組手術時間比較差異有統計學意義，腹腔鏡組手術時間明顯短于傳統組（P ＜0．05），但與無張力組比較無差異。3組住院時間、下床活動時間比較差異有統計學意義，腹腔鏡組和無張力組住院時間及下床時間明顯短于傳統組（P ＜0．05），腹腔鏡組住院時間短于無張力組，差異有統計學意義（P ＜0．05），腹腔鏡組和無張力組下床時間比較差異無統計學意義（P ＞0．05）。腹腔鏡組及無張力組術後均未使用鎮痛藥或肌註止痛針，傳統組有14例術後需服用止痛藥或肌註止痛針。傳統組鎮痛藥使用率均高于腹腔鏡組及無張力組，差異有統計學意義。腹腔鏡組術後2例病人髮生相關併髮癥，併髮癥髮生率明顯低于傳統組及無張力組，差異有統計學意義。3組術後1、3 d VAS 評分比較差異有統計學意義，術後1 a VAS 評分差異無統計學意義。腹腔鏡組術後1、3 d 時 VAS 評分明顯低于傳統組及無張力組，差異有統計學意義。傳統組平均複髮率為6．8％，1、3年複髮率分彆為7．1％（3／39）、5．9％（2／34）。無張力組平均複髮率為5．8％，1、3年複髮率分彆為8．3％（3／36）、3．3％（1／30）。腹腔鏡組術後隨訪3 a 僅1例複髮，複髮率為4．3％（1／23）。結論無張力疝脩補術和腹腔鏡疝脩補術治療腹股溝疝均取得較好的臨床效果，2種術式同樣安全有效，又各自有優勢。腹腔鏡疝脩補術在手術創傷、術後疼痛及術後恢複較前2種術式具有明顯的優勢。疝的脩補術應遵循箇體化、規範化的原則，根據患者具體情況來決定手術方式，充分攷慮疝分型，是否複髮，患者的經濟條件、年齡、基礎疾病等。
목적：대비분석복강경하복고구전간극산수보술、무장력산수보술여전통산수보술적림상료효。방법2001년1월－2004년3월공42례환자채용전통방법수복복고구산（전통조），2004년4월－2014년12월유39례환자행산배충전식무장력산수보술（무장력조），행복강경산수보술26례（복강경조）。관찰3조환자적수술시간、리상시간、주원시간。출원후기록병발증발생정황급복발솔。채용시각모의평분법 VAS 법대3조환자술후1、3 d 급1 a 수방시동통정도진행관찰。결과3조수술시간비교차이유통계학의의，복강경조수술시간명현단우전통조（P ＜0．05），단여무장력조비교무차이。3조주원시간、하상활동시간비교차이유통계학의의，복강경조화무장력조주원시간급하상시간명현단우전통조（P ＜0．05），복강경조주원시간단우무장력조，차이유통계학의의（P ＜0．05），복강경조화무장력조하상시간비교차이무통계학의의（P ＞0．05）。복강경조급무장력조술후균미사용진통약혹기주지통침，전통조유14례술후수복용지통약혹기주지통침。전통조진통약사용솔균고우복강경조급무장력조，차이유통계학의의。복강경조술후2례병인발생상관병발증，병발증발생솔명현저우전통조급무장력조，차이유통계학의의。3조술후1、3 d VAS 평분비교차이유통계학의의，술후1 a VAS 평분차이무통계학의의。복강경조술후1、3 d 시 VAS 평분명현저우전통조급무장력조，차이유통계학의의。전통조평균복발솔위6．8％，1、3년복발솔분별위7．1％（3／39）、5．9％（2／34）。무장력조평균복발솔위5．8％，1、3년복발솔분별위8．3％（3／36）、3．3％（1／30）。복강경조술후수방3 a 부1례복발，복발솔위4．3％（1／23）。결론무장력산수보술화복강경산수보술치료복고구산균취득교호적림상효과，2충술식동양안전유효，우각자유우세。복강경산수보술재수술창상、술후동통급술후회복교전2충술식구유명현적우세。산적수보술응준순개체화、규범화적원칙，근거환자구체정황래결정수술방식，충분고필산분형，시부복발，환자적경제조건、년령、기출질병등。
Objective To compare clinical effect of laparoscopic inguinal hetniorrhapy,the tension-free het-niorrhapy and traditional hetniorrhapy.Methods A total of 42 patients from January 2001 to March 2004 inguinal hernia were used conventional hetniorrhapy.From Apr.to Dec.2004,39 patients were underwent tension-free hetniorrhapy,26 cases were used laparoscopic hetniorrhapy.Operative time,ambulation time, hospital stay of 3 groups were observed.Complications occurrence and recurrence rate were observed.Vis-ual analogue scale (VAS)method was used to evaluate the postoperative pain level 1,3 d after operation, the scores were also evaluated at 1-year follow-up.Results The operative time of the three groups were statistically significant (P < 0.05).The operative time of laparoscopic surgery group was significantly shorter than the conventional group,the difference was statistically significant (P <0.05).But there was no difference between laparoscopic surgery group and ension-free group.Hospital stay,ambulation time of 3 groups were statistically significant.Hospitalization and ambulation time of laparoscopic group and ten-sion-free group were significantly shorter than the traditional group (P <0.05),the difference was statisti-cally significant P <0.05).But ambulation time of laparoscopic group and tension-free group was not sig-nificant differences.Patients of laparoscopic group and tension-free group used no analgesics or intramus-cular injection to ease the pain.In the traditional group,14 cases of patients needed to take painkillers or intramuscular injection to ease the pain,the three groups were statistically significant differences (P <0.05).Analgesic use ratio of traditional group were higher than which in the laparoscopic group and ten-sion-free group,the difference was statistically significant.The complication rate of laparoscopic surgery group was significantly lower than the traditional group and tension-free group,the difference was statisti-cally significant.1,3 d VAS score difference was statistically significant among 3 groups,after 1 year′s fol-low-up,VAS score difference was not statistically significant.VAS scores in the laparoscopic group was significantly lower than the traditional group and tension-free group at the time of 1,3 d postoperative,the difference was statistically significant.Average recurrence rate of traditional group was 6.8%,1-year and 3-year recurrence rate was 77.1%(3/39),5.9%(2/34),respectively.In tension-free group,the average re-currence rate was 5.8%,1-year and 3-year follow-up recurrence rate was 8.3%(3/36),3.3%(1/30),re-spectively.In laparoscopic group,there was only one case of postoperative with recurrence of 4.3%(1/23). Conclusion Traditional hernia hetniorrhapy was not fitted for inguinal hernia hetniorrhapy.Tension-free hernia hetniorrhapy and laparoscopic hetniorrhapy for inguinal hernia have achieved better clinical results, the two procedures equally safe and effective,but also have their own advantages.Laparoscopic hernia het-niorrhapy has obvious advantages in surgical trauma, postoperative pain and postoperative recovery. Hernia repair should be individualized according to the specific circumstances of the patient to determine the surgical approach.We should fullly considerate hernia type,recurrence,the economic conditions of the patient,age and underlying disease.